Undiagnosed hypertension in Croatia.

AIM: To determine the prevalence of undiagnosed hypertension in Croatia, and to assess its association with various demographic, socioeconomic, lifestyle, and health care usage factors. METHODS: We used the data from European Health Interview Survey wave 3, conducted in Croatia in 2019. The representative sample consisted of 5461 individuals aged 15 years and older. The association of undiagnosed hypertension with various factors was assessed with simple and multiple logistic regression models. The factors that contribute to undiagnosed hypertension were identified by comparing undiagnosed hypertension with normotension in the first model and with diagnosed hypertension in the second model. RESULTS: In the multiple logistic regression model, women and older age groups had lower adjusted odds ratio (OR) for undiagnosed hypertension than men and the youngest age group. Respondents living in the Adriatic region had a higher adjusted OR for undiagnosed hypertension than those living in the Continental region. Respondents who did not consult their family doctor in the previous 12 months and those who did not have their blood pressure measured by a health professional in the previous 12 months had a higher adjusted OR for undiagnosed hypertension. CONCLUSION: Undiagnosed hypertension was significantly associated with male sex, age from 35 to 74, overweight, lack of consultation with a family doctor, and living in the Adriatic region. The results of this study should be used to inform preventive public health measures and activities.

Epidemiology of vulvar cancer in Croatia.

AIM: To assess the incidence and mortality trends of invasive vulvar cancer in Croatia between 2001 and 2019/2020. METHODS: The incidence data for the period 2001-2019 were obtained from the Croatian National Cancer Registry. The number of deaths from invasive vulvar cancer by age groups between 2001 and 2020 was obtained from the Croatian Bureau of Statistics. Joinpoint regression analysis was used to assess the trends and trend changes. RESULTS: Joinpoint regression analysis of vulvar cancer incidence rate showed a non-significant average annual percent increase (APC) of 0.8 (95% confidence interval [CI]=-0.3-2.0) during the whole period. There was also a non-significant increase in women under 60, with an average APC of 1.0 (CI = -1.6-3.7) during the whole period; similar results were obtained in women over 60 years of age (APC=0.9; CI=-0.3-2.1). The average annual percent increase in vulvar cancer mortality rate was 0.2% (CI = -1.0-1.5), with a similar trend in women over 60 years of age (APC=0.1; CI=-1.3-1.5). Mortality in women under 60 years of age was not assessed due to a very small number of deaths observed in the study period. CONCLUSION: In the studied period, the incidence of invasive vulvar cancer in Croatia was stable. Age-standardized rates (for all-ages, under 60, and over 60 years of age) increased, but the increase did not reach the level of statistical significance. The pattern in younger and older age groups was the same. The mortality rates over the last decade were stable.

KIDNEY CANCER IN CROATIA - TRENDS IN INCIDENCE AND MORTALITY IN THE 21ST CENTURY.

Kidney cancer is estimated to be responsible for more than 400 000 new cancer cases and 180 000 cancer deaths a year. Its incidence is increasing in the majority of developed countries, due to an increased prevalence of recognized risk factors such as smoking, alcohol use and obesity, as well as incidental findings on unrelated diagnostic imaging procedures. Mortality is decreasing in the majority of European countries, due to improvements in treatment and stage at diagnosis shift with more tumors being diagnosed at an early stage. In this paper, we present kidney cancer incidence and mortality trends in Croatia using joinpoint regression analysis. The incidence was rising throughout the 2001-2019 period, with an annual percent change (APC) of 2.5%; more so in men (APC of 2.5%) than in women (APC of 2.2%). Mortality increased during the 2001-2014 period (APC of 2.4%), but started to decrease in recent years (APC -2.7%, 2014-2020). Unlike sex differences observed in other European countries, with more favorable mortality trends found in women, our study showed a constant increase in mortality in women (APC of 1.2%) and a recent decrease in mortality in men, starting in 2013 (APC of -2.8%), after a period of increase from 2001 (APC of 3.3%).

OPPORTUNISTIC SCREENING FOR COLORECTAL CANCER IN HIGH-RISK PATIENTS IN FAMILY MEDICINE PRACTICES IN THE REPUBLIC OF CROATIA.

Colorectal cancer is a malignant neoplasm which has an increasing incidence and represents a global public health problem. The majority of patients are diagnosed after the age of 50, and the risk of developing it over lifetime is 5%. Development of preventive, diagnostic and treatment methods has resulted in a significant reduction in mortality and other negative clinical outcomes. Precisely because of the efficient method of prevention and early detection of this disease, numerous countries, including Croatia, have organized national colorectal cancer screening and monitoring programs. However, these programs are primarily organized for the population with the usual, i.e. average risk of developing colorectal cancer. High-risk groups include persons with endoscopically detected and removed colon polyps, persons surgically treated for colon cancer, persons with a positive family history of colorectal cancer, persons with inflammatory bowel diseases, individuals and families with hereditary disorders or genetic mutations that increase the risk of this disease several fold, persons with acromegaly, and patients who have undergone ureterosigmoidostomy. Recommendations for the detection and monitoring of high-risk groups are often not defined clearly, and some of the existing ones are based mostly on scarce scientific evidence. It is commonly accepted that screening in high-risk groups should start at an earlier age, with shorter intervals between follow-ups. The basic diagnostic method for screening and monitoring in these patient groups is endoscopic monitoring, or colonoscopy. The aim of this review paper is to present the characteristics of the abovementioned risk groups and provide clear screening recommendations.

Prevalence of somatic comorbidities among coronavirus disease 2019 patients in Croatia in the first pandemic wave: data from national public health databases.

AIM: To determine the prevalence of common somatic comorbidities among coronavirus disease 2019 (COVID-19) positive patients in Croatia in the first pandemic wave, and assess the differences in clinical outcomes depending on the presence of comorbidities. METHODS: We analyzed data from patients confirmed to be SARS-CoV-2-positive from February through May 2020. The data were obtained from clinical laboratories, primary health care providers, and hospitals. Previously recorded comorbidities, including diabetes, cancer, circulatory diseases, chronic pulmonary, and kidney disease, were analyzed. RESULTS: Among 2249 patients, 46.0% were men (median age 51 years; median disease duration 27 days). Hospitalization was required for 41.8% patients, mechanical ventilation for 2.5%, while 4.7% of all patients died. Patients who died were significantly older (median 82 vs 50 years, P<0.001) with a higher prevalence of all investigated comorbidities (all p's <0.001), more frequently required mechanical ventilation (34% vs 1%, P<0.001), and had shorter length of hospital stay (median 13 vs 27 days, P<0.001) with no sex preponderance. Patients requiring mechanical ventilation were significantly older (median age 70 vs 51 years, P<0.001), more frequently men (59.6% vs 45.7%, P=0.037), showed a higher prevalence of all comorbidities except ischemic heart and chronic kidney disease (all p's <0.001), and demonstrated a higher case-fatality rate (63.2% vs 3.2%, P<0.001). CONCLUSION: COVID-19 patients who died in the first pandemic wave in Croatia were more likely to suffer previous somatic comorbidities. This corroborates the findings of similar studies and calls for further research into the underlying disease mechanisms, hence providing ground for more efficient preventive measures.